POS0762 LONG-TERM RENAL OUTCOMES OF PATIENTS WITH NON-PROLIFERATIVE LUPUS NEPHRITIS
Authors: E. Kang, S. Hong, Y. G. Kim, C. K. Lee, J. S. Oh, B. Yoo, S. M. Ahn
Journal: Annals of the Rheumatic Diseases (2022)

Background Although proliferative (class III or IV) lupus nephritis (LN) is the most common finding in the classification of LN, pure membranous (class V) or mesangial (class I or II) LN can occur as a form of LN. Even though non-proliferative LN (class I, II, or V) is a less severe form with good outcomes, data on long-term renal prognosis are limited. Objectives This study investigated the long-term outcomes and prognostic factors in non-proliferative LN. Methods We retrospectively reviewed the medical records of patients with systemic lupus erythematosus who were diagnosed with LN class I, II, V or II+IV by kidney biopsy between 1997 and 2021 at a tertiary referral center. Clinical and laboratory data were compared between patients with and without poor renal outcomes. Poor renal outcome was defined as an estimated glomerular filtration rate (eGFR) of &lt; 60 mL/min/1.73 m2 or death due to renal cause. Univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the factors associated with poor renal outcomes. Results We included 71 patients with non-proliferative LN (4: class I; 17: class II; 48: class V, 17; 2: class II+V). Median follow-up duration was 103 months (interquartile range 27–185) and the overall rate of poor renal outcomes at last follow-up was 29% (21/71), including end-stage renal disease (n=2) and renal death (n=1). Univariate analysis indicated that older age (HR 1.05; 95% CI: 1.00–1.09), low eGFR (HR 0.97; 95% CI: 0.95–0.99) and failure to reach complete remission at 6 months (HR 0.332; 95% CI: 0.12–0.92) were significantly associated with poor renal outcomes. Multivariate analysis revealed that low eGFR at 6 months (HR 0.97; 95% CI: 0.95–0.99) was significantly associated with poor renal outcomes. Figure 1. Renal outcomes at last follow up eGFR, estimated glomerular filtration rate (ml/min/1.73m 2 ) Table 1. Univariate and multivariate Cox proportional hazard regression analyses of the factor associated with poor renal outcomes Parameter Univariate analysis Multivariate analysis HR 95% CI p value HR 95% CI p value Clinical features Age 1.046 1.003-1.091 0.036 1.002 0.960-1.047 0.921 Sex 1.654 0.375-7.298 0.506 SLEDAI 1.036 0.965-1.112 0.327 Extra renal SLEDAI 1.038 0.971-1.11 0.272 Renal profiles eGFR at LN diagnosis 0.993 0.976-1.011 0.456 Proteinuria at LN diagnosis 1.000 1.000-1.000 0.444 &gt; 1g/24 hours 0.669 0.243-1.841 0.437 &gt; 3g/24 hours 0.624 0.229-1.699 0.356 eGFR at 6M 0.967 0.948-0.986 0.001 0.968 0.948-0.988 0.002 eGFR at 12M 0.964 0.947-0.981 0.000 Complete remission at 6M 0.332 0.119-0.924 0.035 0.553 0.179-1.707 0.303 Complete remission at 12M 0.667 0.232-1.914 0.451 Transformation 1.246 0.423-0.701 0.692 Laboratory data Anti-dsDNA 1.001 0.999-1.003 0.196 C3 1.020 1.000-1.041 0.051 C4 1.027 0.969-1.089 0.367 Albumin 1.180 0.661-2.109 0.576 Classification a Class I 0.802 0.102-6.303 0.834 Class II 1.298 0.412-4.088 0.656 Class V 0.887 0.308-2.557 0.824 Class II+V 0.048 0.000-1685 0.837 Medications b ACEi/ARB 1.652 0.603-4.528 0.329 Hydroxychloroquine 1.326 0.414-4.242 0.635 Corticosteroid 1.186 0.154-9.108 0.870 CNI 2.439 0.464-12.824 0.292 MMF 3.788 0.959-14.965 0.057 AZA 0.589 0.133-2.611 0.486 a LN classifications were based on the International Society of Pathology/Renal Pathology Society (ISN/RPS) classification. b Medications maintained at least one year since Lupus Nephritis diagnosis. HR, hazard ratio; 95% CI, 95% confidence interval; SLEDAI, systemic lupus erythematosus disease activity index; eGFR, estimated glomerular filtration rate; LN, lupus nephritis; anti-dsDNA, anti-double strand DNA; C3/C4; complement 3/4; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CNI, carcineurin inhibitor; MMF, mycophenolate mofetil; AZA, azathioprine. Conclusion Poor renal outcomes occurred in approximately 30% of patients with non-proliferative LN (class I, II or V) after long-term follow-up. Our findings suggest that more active management may be needed for non-proliferative LN, particularly in patients with low eGFR at 6 months. Disclosure of Interests None declared